Primary prevention of left ventricular dysfunction and heart failure in cancer patients undergoing chemotherapeutic treatment: a systematic review

Objective: to evaluate the effectiveness of various pharmacological approaches for the primary prevention of left ventricular dysfunction and heart failure induced by anticancer therapy.

Materials and methods: the review was based on an analysis of the PubMed, Embase, Scopus, and Web of Science databases. A systematic literature review was conducted to analyze data on the use of beta-blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, statins, SGLT-2 inhibitors, and mineralocorticoid receptor antagonists. Clinical cases, case series, systematic reviews, meta-analyses, and animal studies were excluded from the results. No time limits were set, and articles published during the lifetime of the databases were analyzed. Studies were included if they reported the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, sodium-glucose cotransporter 2 inhibitors, statins, and mineralocorticosteroid receptor antagonists as primary prevention of left ventricular dysfunction and heart failure in cancer patients.

Results: data on the effectiveness of beta-blockers are contradictory. Angiotensin receptor blockers (in particular, candesartan), angiotensin-converting enzyme inhibitors demonstrate improvement in left ventricular ejection fraction. Statins (atorvastatin and rosuvastatin) have shown effectiveness in primary prevention of cardiotoxicity. SGLT-2 inhibitors have demonstrated promising results in reducing the risk of cardiotoxicity and adverse cardiovascular events. Data on mineralocorticoid receptor antagonists are limited.

Conclusions: beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, and SGLT-2 inhibitors may have a cardioprotective effect in the context of preventing cardiotoxicity caused by anticancer therapy. Additional research is needed to determine the optimal prevention and treatment strategies that take into account individual patient risk factors and the specific therapy being used.

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